Prevalence and Characteristics of Chronic Cough in Adults Identified by Administrative Data

Zeiger, Robert S.; Xie, Fagen; Schätz, Michael; Hong, Benjamin; Weaver, Jessica; Bali, Vishal; Schelfhout, Jonathan; Chen, Wansu

doi:10.7812/tpp/20.022

Cited by 30 publications

(62 citation statements)

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“…In this study we found an overweight of females (62%) and in general the patients were above the age of 50 years which is similar to ndings in other studies reporting demographics of patients with cough (13)(14)(15)(16). Importantly, no differences in age and gender were found based on the selection criteria being by the Prescription or Patient registry.…”

Section: Discussionsupporting

confidence: 91%

“…The most serious cause of chronic cough is lung cancer, and therefore all with cough should have had an Xray performed, but the ndings in the study was only 73% in the population with UCC. These ndings are higher than in similar studies by Zeiger et al (14), whom found that 62% have had an X-ray taken, where fewer had spirometry performed. Furthermore, since the most frequent cause of chronic cough is COPD or asthma, spirometry should also have been performed in all patients and data show the frequency of spirometry performed was even lower than performed X-rays.…”

Section: Discussioncontrasting

confidence: 63%

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A Register-Based Study: Cough - A Frequent Phenomenon in the Adult Population

Backer

Porsborg

Hansen

et al. 2021

Preprint

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BackgroundChronic cough, more than 8 weeks, can either be without co-morbidity called unexplained chronic cough (UCC) or with co-morbidity called refractory chronic cough (RCC). Using datasets from the Danish National Prescription Registry (Prescription Registry) and Danish National Patient Registry (Patient Registry) we wanted to investigate the prevalence of cough in a Nationwide registry from both primary and secondary care setting.Material and MethodsInclusion criteria were patients 18-90 years with at least one final cough diagnosis (ICD-10 DR05/DR059) in Patient registry or patients who have redeemed ≥2 prescriptions for relevant cough-medication within a 90-day harvest in the Prescription registry from 2008-2017. To validate this study’s chosen proxy on chronic cough an analysis of the Patient registry sub-population with a contact of ≥8 weeks and then final diagnosis code DR05/DR059 was also performed. The population was divided into UCC and RCC.ResultsOf the 104.216 patients from the Prescription registry, 52.727 were classified as having UCC and 51.489 were classified with RCC. From the Patient registry 34.260 were included, of whom 12.278 had UCC and 21.982 had RCC. Cough were frequently found among females between 50 and 66 years. Spirometry was performed in 69% and 57%, X-ray in 73% and 58% and asthma challenge test performed in 13% and 5% (UCC and RCC, respectively). The frequency of co-morbidities such as heart failure, rheumatologic disease, pulmonary embolism, and diabetes was < 10%. The distribution of all the included variables of patients who have had attachment to the department for 8 weeks or more, was similar as in the main group, thus fewer.ConclusionMany patients suffer from chronic cough or cough requiring medications, with or without co-morbidity; frequently found among menopausal women. Most patients had a substantial work-up performed. The high frequency and the resources consuming work-up program call for systematic coding of disease, systematic patient evaluation and more specific treatment options.The study was accepted by the Danish Data Protection Agency (ID: no. P-2019-191)

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 63%

A Register-Based Study: Cough - A Frequent Phenomenon in the Adult Population

Backer

Porsborg

Hansen

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Recent studies from the US reported the disease burden in patients with chronic cough (vs. those without chronic cough), including increased healthcare resource utilization, outpatient visits, diagnostic tests, and treatment needs [12][13][14]. Our ndings are generally in line with these [12][13][14]. We found a substantial proportion of patients who required additional diagnostic tests, drug treatments, and outpatient visits, among the new referrals.…”

Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 75%

Cough presentation and cough-related healthcare utilization in tertiary care: analysis of routinely collected academic institutional database

Lee

Won³

et al. 2022

Preprint

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Background: Most knowledge on cough epidemiology was obtained from questionnaire surveys of general populations or small focused studies of patients visiting specialist clinics. Routinely collected data (RCD) from electronic health records (EHR) are useful sources for studying disease epidemiology, but their use was limited in chronic cough. The present study aimed to investigate cough presentation and cough-related healthcare utilization, using the RCD of patients referred with cough.Methods: This is a retrospective cohort study utilizing an academic institutional EHR database. Cough cases were identified using the text search for the chief complaint indicating “cough” in the structured case report form. Using the information, we constructed a retrospective cohort of patients with subacute or chronic cough. Baseline demographics, medical history, concomitant symptoms, and diagnostic tests were analyzed. Healthcare utilization during 1 year since the baseline visit was assessed for drug prescriptions, additional diagnostic tests, outpatient visits, and hospitalization.Results: Among a total of 28,312 new referrals, cough was the chief complaint in 13,223 cases (46.7%). Based on the selection criteria, 3,810 subacute and 7,150 chronic cough patients were finally included. A common demographic profile was middle-aged woman (mean age 52.1 years, and female 63%). Patients had a median three accompanying symptoms (interquartile range: 2–5). Abnormal throat sensation (globus, tickling, or dryness) was the most common (about 70%), but symptoms suggesting nasal diseases, asthma, or acid reflux were also frequent. During the first year, both of subacute and chronic cough patients required multiple drug prescriptions, diagnostic tests, and outpatient visits, but the degree of utilization was higher in patients with chronic cough. Codeine-containing drugs were given to 21.5% of patients with chronic cough, and oral antibiotics to 23.7% and oral steroids to 9.9%.Conclusions: Cough is a common chief complaint among new referrals to tertiary specialist clinics. Cough is accompanied by multiple symptoms and is associated with healthcare utilization, particularly more in patients with chronic cough. Further studies are needed to understand their long-term health outcomes and reduce the disease burden.

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“…The study population included individuals with specialist-diagnosed CC, indicated by an internal CC encounter code. The NLP algorithm identified additional individuals with predicted CC from the same database; this clinically undiagnosed group had lower rates of diagnostic testing and medication prescriptions than the specialist-diagnosed CC group, and higher HCRU [ 20 ]. These findings illustrate the importance of enhanced methods to identify and characterize CC, to improve its diagnosis and treatment.…”

Section: Introductionmentioning

confidence: 99%

Development of a natural language processing algorithm to detect chronic cough in electronic health records

et al. 2022

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Background Chronic cough (CC) is difficult to identify in electronic health records (EHRs) due to the lack of specific diagnostic codes. We developed a natural language processing (NLP) model to identify cough in free-text provider notes in EHRs from multiple health care providers with the objective of using the model in a rules-based CC algorithm to identify individuals with CC from EHRs and to describe the demographic and clinical characteristics of individuals with CC. Methods This was a retrospective observational study of enrollees in Optum’s Integrated Clinical + Claims Database. Participants were 18–85 years of age with medical and pharmacy health insurance coverage between January 2016 and March 2017. A labeled reference standard data set was constructed by manually annotating 1000 randomly selected provider notes from the EHRs of enrollees with ≥ 1 cough mention. An NLP model was developed to extract positive or negated cough contexts. NLP, cough diagnosis and medications identified cough encounters. Patients with ≥ 3 encounters spanning at least 56 days within 120 days were defined as having CC. Results The positive predictive value and sensitivity of the NLP algorithm were 0.96 and 0.68, respectively, for positive cough contexts, and 0.96 and 0.84, respectively, for negated cough contexts. Among the 4818 individuals identified as having CC, 37% were identified using NLP-identified cough mentions in provider notes alone, 16% by diagnosis codes and/or written medication orders, and 47% through a combination of provider notes and diagnosis codes/medications. Chronic cough patients were, on average, 61.0 years and 67.0% were female. The most prevalent comorbidities were respiratory infections (75%) and other lower respiratory disease (82%). Conclusions Our EHR-based algorithm integrating NLP methodology with structured fields was able to identify a CC population. Machine learning based approaches can therefore aid in patient selection for future CC research studies.

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Prevalence and Characteristics of Chronic Cough in Adults Identified by Administrative Data

Cited by 30 publications

References 0 publications

A Register-Based Study: Cough - A Frequent Phenomenon in the Adult Population

A Register-Based Study: Cough - A Frequent Phenomenon in the Adult Population

Cough presentation and cough-related healthcare utilization in tertiary care: analysis of routinely collected academic institutional database

Development of a natural language processing algorithm to detect chronic cough in electronic health records

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